GI bleeds

Question 1

List 10 DDX for lower GI bleeds

Answer 1

Colitis
Hemorrhoids
Andiodysplasia
Neoplastic
Diverticular disease
Perforation 
Coagulopathy 
Endometriosis
Intussusception 
Fissures
Radiation 
Post polypectomy

Question 2

List 5 ddx for lower GI bleed in children

Answer 2

Cows milk allergy 
Polyps 
Meckles diverticulum 
IBD
Intussuception

Question 3

List five red flags for GI bleeding

Answer 3

Wt loss
Syncope
Diaphoresis
Hypotension 
Tachycardia
Pale

Question 4

List 10 ddx for upper GI bleeding

Answer 4

PUD
Varicies
Mallorey Weiss
Erosive esophagitis
Gastritis
Epistaxis
CA
Aortoenteric fistula 
Coagulopathy 
Ateriovenous malformation 
Hemobilia

Question 5

List 5 risks for GI bleeds

Answer 5

Previous Bleeds 
ICU stay 
Alcohol 
Smoking 
Liver disease (due for varicies and due due to low platlets)

Question 6

List three non medical causes for changes to the color of the stool

Answer 6

Iron
Beets
Pepto bismol

Question 7

What are the risks of being on long term PPI and what should you do about it

Answer 7

C. Diff*
Hip fractures
Pneumonia
Low Vit B12, iron, magnesium and clacium

Try to taper to H2 receptor aconists (ranitidine) or reduce to PRN or lower dose or q 2 days

Question 8

What to do in an acute GI bleed

Answer 8

ABC MOVIES 
Monitor
Oxygen 
Vitals 
IV
ECG
Sugar check 

Transfuse if Hb <70
Start on PPI and Macrolide (erythromycin)
Scope but not urgent

IF Varicies start on Ceftriazone (cephalosporin) and somatostatin (octerotide)

NOT TXA

Do everything serially like vitals, ABCs and ECGs

Question 9

How do you reverse Warfarin, Heparin, and Dabigatran (Direct thrombin inhibitor)

Answer 9

Warfarin: Vitamin K
Heparin: Protamine (antidote) Fresh frozen plasma
Dabigatran : Praxbind (idaruzizumab=monoclonal antibody)